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Illinois rates for HCPCS A4435

Ostomy pouch, drainable, high output, with extended wear barrier (one-piece system), with or without filter, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.98 / $3.98 / $8.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $5.01 / $7.94
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.13 / $8.13 / $8.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.38 / $46.77 / $89.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.37 / $6.03 / $6.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.79 / $4.79 / $9.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.07 / $4.07 / $8.91
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.13 / $12.59 / $16.22
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.47 / $10.47 / $10.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.40 / $3.16 / $8.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.82 / $3.98 / $6.46